U.S. House of Representatives U.S. Senate. U.S. House of Representatives U.S. Senate

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1 Harold P. Wimmer National President and CEO December 6, 2017 The Honorable Paul Ryan The Honorable Mitch McConnell Speaker Majority Leader U.S. House of Representatives U.S. Senate H-232, The Capitol S-230, The Capitol Washington, DC Washington, DC The Honorable Kevin McCarthy The Honorable Chuck Schumer Majority Leader Minority Leader U.S. House of Representatives U.S. Senate H-107, The Capitol S-221, The Capitol Washington, DC Washington, DC The Honorable Nancy Pelosi Minority Leader U.S. House of Representatives H-204, The Capitol Washington, DC Dear Speaker Ryan, Leader McConnell, Leader McCarthy, Leader Schumer and Leader Pelosi: As Congress works to finalize appropriations bills for (FY18), the American Lung Association respectfully requests Congress to continue to support funding for programs that will promote lung health and reduce lung disease. The American Lung Association also asks for your leadership in opposing all policy riders that would weaken key lung health protections in both the Clean Air Act and the Tobacco Control Act. Policy riders have no place in appropriations bills, and the Lung Association strongly opposes attempts to include them, including riders that would make it harder to protect Americans from air pollution and children from tobacco products. The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through education, advocacy and research. Lung disease is the third leading cause of death in the United States and lung cancer is the leading cancer killer among both women and men. Twenty-five million people, including six million children, suffer from asthma. The nation is making progress to combat this toll, but this advancement can only continue with sustained investment and strong laws that are not weakened by political riders on these appropriations bills. Advocacy Office: 1331 Pennsylvania Avenue NW, Suite 1425 North Washington, DC Ph: F: Corporate Office: 55 West Wacker Drive, Suite 1150 Chicago, IL Ph: F:

2 The American Lung Association also asks for your leadership to help ensure adequate funding exists for these key lung health programs by continuing the bipartisan practice of providing relief from sequestration budget cuts and opposing any new efforts to cut these nondefense discretionary (NDD) programs more deeply. NDD programs have been subject to repeated cuts over the past six years, including through the appropriations caps and sequestration process established by the 2011 Budget Control Act. These cuts threaten the lung health of our nation. Congress should avoid making further reductions in these programs and work to replace the scheduled sequestration cuts through a package that is balanced both in how such relief is paid for and how it is applied between defense and NDD programs. The American Lung Association is grateful for your support. Please contact Erika Sward (Erika.Sward@Lung.org or ) with any questions. Thank you for your consideration of our recommendations. Sincerely, Harold P. Wimmer National President and CEO FY18 L-HHS Appropriations Priorities Provide $36.1 Billion for the National Institutes of Health (NIH) Research supported by NIH has been instrumental in the fight to identify the causes of and effective treatments for lung diseases. The American Lung Association supports increased funding for NIH research on the prevention, diagnosis, treatment and cures for tobacco use and all lung diseases including lung cancer, asthma, COPD, influenza and tuberculosis. The Lung Association supports recent funding increases for precision medicine, but also believes that individual institutes within NIH need robust, sustained federal research funding increases to ensure the pace of research is maintained across NIH. Provide at least $29.0 million for the Centers for Disease Control and Prevention s (CDC s) National Asthma Control Program (NACP) It is estimated that 25 million Americans currently have asthma, of whom 6 million are children. The NACP tracks asthma prevalence, promotes asthma control and prevention and builds capacity in state programs. This program has been highly effective: the rate of asthma has increased, yet asthma mortality and morbidity rates have decreased. At present, 24 states and Puerto Rico receive funding.

3 Provide $220 million for CDC s Office of Smoking and Health (OSH) The American Lung Association supports $220 million for the Office of Smoking and Health at CDC. OSH is the lead federal agency for tobacco prevention and control and created the Tips from Former Smokers Campaign, which has prompted hundreds of thousands of smokers to call QUIT-NOW or visit smokefree.gov for assistance in quitting with even more smokers making quit attempts on their own or with the assistance of their physicians. Smoking is the leading cause of preventable death in the United States and costs the U.S. over $332 billion in healthcare costs and lost productivity. As such, support for tobacco cessation and prevention activities is among the most effective and cost-effective investments in disease prevention. Provide $10 million for CDC s Climate and Health Program CDC s Climate and Health Program is the only HHS program devoted to identifying the risks and develop effective responses to the health impacts of climate change, including worsening air pollution; diseases that emerge in new areas; stronger and longer heat waves; more frequent and severe droughts, and provides guidance to states in adaptation. Pilot projects in 16 states and two city health departments use CDC s Building Resilience Against Climate Effects (BRACE) framework to develop and implement health adaptation plans and address gaps in critical public health functions and services. As climate-related challenges intensify, CDC must have increased resources to support states and cities in meeting the challenge. FY18 Interior-Environment Appropriations Priorities Provide $469 million for EPA s Clean Air and Climate program EPA s work to protect people from the impacts of air pollution saves lives and improves health, especially for populations most at risk, including those with asthma and other lung diseases; children; older adults; people living in low-income communities; people who work, exercise or play outdoors; and people with heart disease and diabetes. Funds under this program are used in part to assist states, tribes, and local air pollution control agencies in the administration of programs and standards to protect the air we breathe. States have the primary responsibility for developing clean air measures necessary to meet federal standards, but rely on support and assistance from EPA to create effective comprehensive air quality management programs. Funds also reduce carbon pollution, methane, and other climate pollutants to protect public health from the impacts of climate change. Please provide $341 million for Environmental Program and Management and $128 million for Science and Technology.

4 Provide $281 million for Categorical Grants: State and Local Air Quality Management and Tribal Air Quality Management State, local and tribal air pollution agencies need more funding, not less, to ensure proper protection of the public through implementation of the Clean Air Act. These agencies are on the front lines of vital efforts to improve air quality and protect public health, yet they are perennially underfunded. This must change in order to secure the benefits promised by Clean Air Act protections. Please provide $268 million for State and Local Air Quality Management and $13 million for Tribal Air Quality Management. Provide $75 million for the Diesel Emissions Reduction Grant Program Ten million old diesel engines are in use today that pollute communities and threaten workers. Immense opportunities remain to reduce diesel emissions through the DERA program. The Committee s continued investments in this program have yielded between $5 and $21 in health benefits for every $1 in retrofitting. Please provide at least $75million in FY Provide $8.1 million for the Categorical Grant: Radon Radon is the second leading cause of lung cancer in the United States, and the EPA s State Indoor Radon Grants are the only nationwide program that helps prevent exposure to it. States and tribes depend on this program as well as technical assistance through the Radon Programs to educate the public and fight this deadly carcinogen. In 2003, the National Academy of Sciences estimated that radon kills 21,000 people each year. FY18 Agriculture-FDA Appropriations Priorities Appropriate the $672 million in authorized user fees for the Center for Tobacco Products FDA s activities to protect our nation s youth and the public health from tobacco products is entirely paid for by user fees. The American Lung Association strongly supports full appropriation of these authorized user fees, and strongly opposes any riders that would weaken or take away FDA s authority over cigars, or any riders that would grandfather in all e-cigarettes or cigars. The Lung Association also strongly supports FDA s The Real Cost Campaign, which according to a January 19 study published in the Morbidity and Mortality Weekly Report, has prevented approximately 350,000 of our nation's youth from starting to smoke. FY18 Transportation-Housing and Urban Development Appropriations Priorities Provide $20.0 million for the Department of Housing and Urban Development s Office of Lead Hazard and Healthy Homes The Department of Housing and Urban Development s (HUD) Office of Lead Hazard and Healthy Homes plays a vital role in improving the lung health of public and other types of housing under HUD. Currently, public housing authorities are working to implement the smokefree housing rule that will protect the two million public housing authority residents, including 760,000 children,

5 from the dangers of secondhand smoke in their homes. Improving air quality by eliminating toxins like secondhand smoke and mold will improve the lung health of all public housing residents. They also actively work to fight the second leading cause of lung cancer in homes radon. Thank you for your consideration of our funding recommendations. Again, we ask for your opposition to all policy riders.